Advancing Governance and Citizenship in the Ugandan Health Sector

For as long as Jordan Bateisibwa can remember, resources and funding for maternal healthcare have been scarce in his native country of Uganda.

“When my mother was pregnant with me, she had to travel over 30 kilometers to get to the nearest healthcare center,” he recalled.

Now, Bateisibwa is part of a developing project—formally known as Community-Centered Development in the Ugandan Health Sector—that aims to transform and improve healthcare for women and children in Uganda.

When you go through difficulties, you don’t want others to have to go through them too.
—Jordan Bateisibwa

Supported by Progressive Health Partnership (PHP)—a nonprofit focused on reducing disease burdens especially for mothers—and funded by the Center for Global Health Equity (CGHE), the Community-Centered Development Project sits at the intersection of public health, economics, and political economy. The project focuses on healthcare quality in underserved communities.

Bateisibwa, director of programs for PHP, said his humble childhood motivated him to help others, especially mothers in rural communities. “When you go through difficulties, you don’t want others to have to go through them too,” he said.

That mindset led Bateisibwa to work with Josh Greenberg, an MD/PhD candidate at the University of Michigan, to co-found PHP in Uganda more than a decade ago.

While he was still an undergraduate student, Greenberg met Bateisibwa, and together they worked to launch PHP. He said the idea of starting the Community-Centered Development Project came about when he and Bateisibwa were meeting with mothers who had just given birth.

“We were inspired by a particular woman who described the shortcomings in healthcare delivery that she experienced at a local public health facility. She described several accountability gaps in the service provision, and she knew that things could be better,” Greenberg remembered.

The woman’s story was echoed by other members of the community, and the team began to ask how to approach the problem. “We started thinking about the fundamentals of social organization. We went back to the basics,” Greenberg said. “What role do governments play in citizens’ lives? Who is responsible for providing resources and services to people? How can the Ugandan government strengthen its own systems of health service provision?”

Greenberg, Bateisibwa, and team began engaging with communities to organize meetings between citizens and local leaders as a way to initiate discussions that could lead to tangible change in the governance of local health facilities. They also connected with the Office of the Prime Minister, which is now assisting in the expansion of the citizen-leader meeting idea into a working model that can be applied in other communities.

When you bring citizens, local leaders, and healthcare providers together to address health-related issues, you can find ways to create a more efficient healthcare system and to improve health outcomes.
—Elisa Maffioli

Timothy Lubanga, commissioner for monitoring and evaluation in the Office of the Prime Minister, is using lessons from the project to spearhead improvements to the Government Nationwide Community Information Monitoring System, also known as Barazas. “Based on the knowledge we are gaining from this project, we are adopting new methodologies to empower local leaders at the sub-county and parish levels with monitoring skills and tools to enable them to execute their oversight roles more effectively,” Lubanga noted.

Elisa Maffioli, assistant professor of Health Management and Policy at the University of Michigan School of Public Health and an expert in health economics and policy said that addressing the institutional aspects of healthcare delivery is not only necessary but an opportunity for empowerment.

“In this specific setting, local leaders can influence what types of healthcare are provided at the community level. They can take tangible steps to ensure that government resources are allocated as intended,” Maffioli explained. “When you bring citizens, local leaders, and healthcare providers together to address health-related issues, you can find ways to create a more efficient healthcare system and to improve health outcomes.”

Health leadership training session in Mbarara, Uganda, for local leaders from throughout the Ankole region.

The relationships that grew out of these meetings became the foundation for two interventions the team is developing for use in Ugandan communities. The first is a citizen-leader meeting, a space for marginalized community members—especially women—to voice their concerns and perspectives to local leaders.

We’ve been able to combine research directly with healthcare policy.
—HaEun Lee

The second involves training local leaders to give them tools and knowledge for implementing public health improvements once they’ve worked with both their constituents and local health facilities to identify issues.

HaEun Lee, an Impact Scholar with CGHE and a member of the team, has been in Uganda supporting the implementation of these interventions.

“These trainings take many forms, from teaching local leaders how to monitor healthcare facilities, resources, and personnel at these facilities to providing platforms for local leaders to share their experiences and learn from each other,” Lee said. “At the core of these interventions are skill-building, consistency, and community engagement to empower leaders to better serve their local jurisdictions.”

A central component of the Community-Centered Development Project is the chance to collaborate with partners from a diverse range of fields and backgrounds.

“We’ve been able to combine research directly with healthcare policy,” said Lee. “Working with a range of experts allows for brainstorming, exchanging ideas, and working together in a way that is really bringing the project to life.”

“We are so grateful the Center has been able to support the scaling-up of this initiative. Working within the Center’s supportive culture and environment—and with colleagues in different fields, including the Center’s Impact Scholars—has really enriched the project,” Maffioli said.

The team is moving into phase 2 of the project—expanding the interventions across a much wider geographic area and conducting research to determine the effectiveness of the strategies.

“Initiatives like this are of particular interest to the Center,” said Joseph Kolars, CGHE director. “We’re grateful for the opportunity to learn from local partners about strategies that strengthen the ability of communities to have more agency for their health and well-being.”

As the Community-Centered Development Project continues to take shape, its success will rely on a truly cross-disciplinary and cross-sector approach to improving healthcare for women and children in Uganda.

“That leaders can be engaged to help improve health services really opens people’s eyes,” Bateisibwa said. “From there, you can start working toward necessary change.”

Other members of the grant team include Fred Muhumuza (Makerere University), Timothy Lubanga (Office of the Prime Minister), Jody Lori (UM), and Dean Yang (UM). The next phase of the Community-Centered Development Project will be advanced by LAUNCH program funding for Greenberg from the National Institutes of Health Fogarty International Center.

—Jaynab Akhtar

Above. A community member speaking at PHP-organized health meeting between citizens and local chairperson in Kagongi Subcounty, Mbarara District, Uganda